Much has been said in the Internet world about the coming of the machines and our displacement or replacement. Maybe we fail to see the cyborgs already among us. The surgeon using the Da Vinci surgical robot, using 3-D reconstructions on the fluoroscopy screen to navigate through blood vessels to place wires, hearing aids that Bluetooth to our phone, my surgical glasses that magnify the view. The machines have been around for some time so why is there this churning discomfort? Surgeons welcomed rather than dreaded the arrival of surgical glasses in the early 80’s; I don’t know of a physician who felt belittled by them. Similarly, the da Vinci has been adopted (after some sticker shock) and which surgeon feels replaced, rather than enhanced?

As a vascular surgeon I have done my share of leg amputations and as you would expect, sharing the necessity of the procedure and it’s social, financial and psychological aftermath with the patient drains you of emotional energy. You want to walk a line acknowledging the devastation you bring with a hope for rehabilitation to life greater than initially envisioned. I think I walked that line fairly well, stressing relief of pain, an end to being a ‘patient,' a chance for better mobility than they have had for some time. But as a specialty, I suspect that we have, for the most part, failed. Why do I say that? Well, nearly all of our scientific knowledge is couched regarding limb salvage, you rarely read a paper that describes mobility, a return to a normal life space or life. I think, at least for me, there was a difficulty visualizing life without a limb. It was outside of my experience of life. It was a foreign territory and while I could cushion the beginning of the journey, and cheer from the sidelines for the triumphs along the way I was never really a participant in that community.

The podcast, On Being, featured a conversation with Dr. B. J. Miller the director of the Zen Hospice Project in San Francisco and a member of the UCSF faculty. He is also an amputee. And sometime in their conversation, the topic turned a bit to his recovery, his rehabilitation. Here is the audio which I encourage you to listen to, it is only a moment but hearing his tone is so reinforcing. An excerpt of the excerpted transcript follows after the jump.

DR. MILLER: …And I worry, sometimes, that we exist in such a narrow bandwidth of accepted behaviors and thoughts that we really clip off so much of the strange beauty that can be part of the human experience. … I remember I was about two or three or four years into my odyssey in these shoes, and the norm for lower limb prostheses, the norm was that you put these flesh-colored foam covers over your legs so that they look more natural, and they have the shape of a leg. And I remember studying architecture at Princeton, modern architecture in particular, and about Louis Sullivan and others pulling the appliqué off the buildings and delighting in the structure itself. And that was just such a mind-blower for me. And so I pulled the covers off my legs and started to force myself, and then to genuinely delight in this weird structure that now was my legs. I love these legs. These legs aren’t some cheap imitation of what I lost. These are wholly new things. These are different things that deserve their own space and credit. I love them, and I am interested in how they look. … there’s the beauty of the carbon fiber weave — carbon, our basic, organic substrate. Here it is in these sheets of woven material that are so strong, so light, such a nod to both Mother Nature and to human ingenuity for harnessing it. So we’ve got this beautiful, black carbon weave. If you buy your sports car, you’ll pay extra to have a carbon fiber door or panel. It’s an acknowledged aesthetic. So, first, I noticed the color. Then I noticed the sculptural quality of the piece, what’s called the socket, and the socket is what goes around my stump, what’s left of my fleshy leg. And that is sculpted to my leg, so it is a piece of sculpture. This is where the craft comes in, and it has sculptural qualities to it. It reveals the shape of my stump. And then, below that, you’ve got this — I’ve had various feet over the years. Some of them have these very narrow, skinny little ankles. It’s almost a version of what I feel like when I look at a horse — that incredible power, those beautiful thighs on these teeny, tiny little ankles. And it’s similar, not quite that dramatic, but it’s a little similar with prosthetic feet, because, in a way, we are able to construct things which are stronger than bone and don’t need all the support structures. So that’s what I see when I look at my legs. 

And that is when I realized I was listening to a cyborg, and it was neither fearful nor unpleasant. It was different in the way Miller had expressed; it was an expansion of healthy. He had made the jump that I couldn’t. Amputation was a professional failing. And while I had tried to smooth the passage for my patients I shared the fate of Moses seeing the future but unable to enter the land up ahead.

Most of us are already cyborgs, humans enhanced by technology. It is for us to expand our normal to take comfortable advantage of what technology is bringing to us.